Leeds Asylum Seekers Support Network
Membership form
Becoming a member is important to LASSN in three ways
 Membership is a statement of support for LASSN and a way of saying that you endorse our aim
to make a positive difference to the quality of life of refugees and asylum seekers, recognising the
intrinsic dignity and worth of all people

Members are vital to the running of the organisation. Membership allows you/your
organisation to vote at LASSN’s Annual General Meeting, to elect LASSN’s trustees and vote on
other business. It could also mean putting yourself forward as a potential trustee.

Members can get involved with campaigning and influencing others.
We need members to attend our Annual General Meeting. Therefore I’d encourage you to pencil in Friday 9th
October 2015, 6.30pm at the Headingley Heart Cafe.
Jon Beech, Director
LASSN, Ebor Court, Westgate, Leeds LS1 4ND
Membership:
I would like to become a member of Leeds Asylum Seekers Support Network. I want to make a positive difference
to the quality of life of refugees and asylum seekers and recognise the intrinsic dignity and worth of all people.
Membership is free for asylum seekers, unwaged people and LASSN volunteers and regular donors. (I note that
if I fall in the free membership category that I am a member until I stop membership either by informing you or if
my circumstances change.) Please inform LASSN if you wish to cancel membership at any time.
A suggested minimum donation of £10 for individuals/unfunded organisations; or £25 for funded organisations.
You can send a cheque, arrange an online transfer or fill in the attached form to set up an annual standing order.
Cheques should be made payable to “LASSN”. BACS direct transfers go to our bank account number 20109321
sort code 60-83-01.
Signed ………………………… Name ….……………………….…… Organisation (if relevant) ………………
Address ………………..........…………………………………………………….…………………………………….…
Tel ……………………..........….. Email ……………………………….……………………………………….……….
LASSN is a charity and a company limited by guarantee. In the event of LASSN being wound up and
having debts then each member would be liable to pay up to £1.
If you can Gift Aid your donation we will reclaim the tax
Please treat as Gift Aid donations all qualifying gifts of
money made:
Today

Since _________________(Within past 4 years) 
In the future

Please tick all boxes you wish to apply.
I confirm I have paid or will pay an amount of Income Tax
and/or Capital Gains Tax for each tax year (6 April to 5
April) that is at least equal to the amount of tax that all the
charities or Community Amateur Sports Clubs (CASCs)
that I donate to will reclaim on my gifts for that tax year.
I understand that other taxes such as VAT and Council
Tax do not qualify.
I understand the charity will reclaim 25p of tax on every
£1 that I give on or after 6 April 2011.
Please notify LASSN if you:
Want to cancel this declaration; Change your name or
home address; or no longer pay sufficient tax on your
income and/or capital gains.
If you pay Income Tax at the higher or additional rate and
want to receive the additional tax relief due to you, you
must include all your Gift Aid donations on your SelfAssessment tax return or ask HM Revenue and Customs
to adjust your tax code.
Signed ……………………………………………………………………………
Leeds Asylum Seekers’ Support Network Standing Order Form
If you are setting up to make a regular contribution to Leeds Asylum Seekers’ Support Network we would
ask you to complete the form below, together with a Gift Aid declaration (for UK taxpayers).
Please complete in block capitals.
1. Your details
Title: Click here to enter text.
First name: Click here to enter text.
Surname: Click here to enter text.
Address: Click here to enter text.
Postcode: Click here to enter text.
E-mail: Click here to enter text.
2. Your regular gift
Please pay to
Leeds Asylum Seekers’ Support Network, Unity Trust Bank plc,
Nine Brindleyplace, Birmingham, B1 2HB
Bank sort code: 60-83-01
Account no: 20109321
£2 ☐ £5 ☐
£10 ☐ or my preferred amount of £ Click here to enter text.
each month ☐ / quarter☐ / year ☐ until further notice
starting on: Click here to enter text. (eg 7th December 2014)
Your Bank Name:
Click here to enter text.
Address:
Click here to enter text.
Postcode:
Click here to enter text.
Account Number:
Click here to enter text.
Sort code:
Click here to enter text.
3. Gift Aid declaration
By making a Gift Aid declaration you will allow LASSN to reclaim tax on your donation.
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6
April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur
Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other
taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on
every £1 that I give.
I would like Leeds Asylum Seekers Support Network to treat all donations I have made for the last 4 years
and all donations in the future as Gift Aid donations until I notify them otherwise. I am a UK taxpayer.
Signature:
Date: Click here to enter text.
Please return this form to: LASSN, Ebor Court, Westgate, Leeds LS1 4ND